As a Swede I do not agree with a lot of what was said in this paper, much seems to be more of an opion than fact. This is a clear poltical subject, as you often see when this is discussed on American forums, it's very hard to talk about these ideas without getting into us vs. them. The hardest part of all this pandemic was that it was so easy to say the wrong thing and getting judged unless you were among people that actually cared about what you were saying.
EDIT removed opinions that still can not be discussed in a sane manner.
Well, this is a peer reviewed paper, arguing quite coherently that the handling of the pandemic in Sweden did not follow scientific methods, and they have a ton of references to back up that opinion. If you are aware of similar papers arguing against this opinion, please provide links.
Expect that this Hacker News thread will be overrun by Swedish patriots who will, with tooth and nail, argue for Swedish exceptionalism and downvote all criticism. War is Peace and all that.
I am ashamed how my country handled this pandemic and I'm ashamed that my fellow citizens are more interested in managing the public image of Sweden rather than learning from obvious mistakes.
I am therefore thankful that Nature published this. It has been debated since early 2020, but the narrative of Swedish exceptionalism is so strong, especially on the Internet, that I wouldn't be surprised if this will tried to be burried.
I have lost friends due to this, not because people have died of Covid but because foreign nationals, who moved to Sweden to work on some of the famous tech companies, have realized how poorly Sweden handled the pandemic. They have now moved to other countries instead.
I've never met a group of people who did not see themselves as special, this view is common in all countries I've lived in. I wonder if someone has tried to measure it objectively.
I am a Swede and I think most of my peers are delusional fans of our institutions and leaders. The leaders tries to cover up everything, and holds no accountability. People are such fans of Anders Tegnell - the man who uses an extreme amount of words to say almost nothing, in addition to almost never admitting to failure or being wrong. They go hand in hand with the politicians on this part.
I seem to remember that he did publicly admit certain policies were poor in retrospect - a bit of googling e.g. finds this, just months after the start of the pandemic: https://www.bbc.com/news/world-europe-52903717
Note that this paper is published in "Nature Humanities and Social Sciences Communications" journal, not in the plain "Nature" journal that is a totally different journal published by the same editorial. I'd also thrust more a pare published in one of the many journals of Nature that has something about medicine or biology in the title, because the reviewers and editors are more specialized in this subject. https://www.nature.com/siteindex
Science and policy are only weakly related. Especially when it comes to things like acting out of caution (assuming the worst given scientific knowledge) and how to weigh personal freedoms and so on.
The discussion of the science of childrens psychological health for example was curiously absent in countries that argued that science demanded swift lockdowns. Is a life-year in lockdown for a school aged child as “lost” as a year shorter lifespan for an elderly person? Or less? Or more?
These are ethical and political questions more than they are scientific.
These ethical problems and differences in how they are handled are present even absent a pandemic. Who’s given intensive care over a certain age for example is likely very different in the US and Sweden. That’s not because the medical facts differ or doctors in either end act on bad science or in bad faith. Medicine isn’t just science, it’s ethics, politics, economics too.
Which science? The science that said masks aren’t needed, then needed and any mask will do, then no, clothe masks don’t work, then oh, it should have been N95 masks all along?
The science remains the same, until we learn new facts and adjust our knowledge. The political pressures and decisions that shaped public decisions and speeches are a different thing, please don't conflate those.
Yes, that science. The one that looks at available data and reassesses, rather than taking a potentially incorrect stance and sticking with it for no reason other than to save face.
"The science" never made a reassessment on masks though, we didn't learn anything new about how masks work and how effective cloth vs N95 etc. All of the posturing on masks was political. So "Trust the science" really became "trust our politicians bro".
Sure, there was and is political posturing with regard to pandemic countermeasures.
The reassessments haven't been about learning how masks work but about how a particular virus spreads and the efficacy of various types of masks in various settings between parties of varying contagion levels. The advice also has to be grounded in practicality given current circumstances (supply constraints, rate of asymptomatic spread among vaccinated populations, etc)
Many conventional wisdoms we're overturned during these last couple of years. Saving mask for the health care services might have been a reasonable thing to do 20 years ago. But today with Chinese extreme mass production it is entirely feasible in rich states to equip their populations with sofisticated face masks and test for virus infection with anti-gen tests several times every week.
Just because something is published does not make it fact. There is a definite bias at publishing houses to “be on the right side of history” and so some opinions will get squashed or not published.
Look at:
The mask paper that was talked about but was never published because the results were inconvenient.
Anytime statistics blow up a narrative.
The Swedes actually followed the science by listening to all the recommendations prior to the pandemic. The best example of this is the WHO or the CDC prior to the outbreak having published and peer reviewed papers that said lockdowns do not work.
Now the next comparison to do is that the approaches of all the other countries followed lockdown. Sweden did not. They then proceeded to have no significant death differences between countries. Seeing that, there will be significant mental differences and knock on effects from the different reactions.
Ultimately, the Swedes got it right by not panicking, followed the non politicized science, and keeping calm and carrying on.
Sweden did get things right, however it also got things wrong.
Lockdowns and masks are both largely non-effective, Sweden got that right, however what Sweden got wrong was the care for the elderly, many deaths that could have been prevented with proper care, but many of them never got to a hospital.
Not effective against a virus like this. It might be effective against something else, but at this point SARS-CoV-2 is the second fastest spreading pathogen in human history.
The paper argues that Sweden didn't get it right but could have easily gotten a better result by incorporating scientific methods better into their public health approach.
Just by advocating masks more and having better policy on trying to save people from dying via hospital care, they could likely have saved maybe a quarter of their total deaths.
>By scientific evidence, in the context of this paper, we refer to the advice of international authorities in infection control (including the World Health Organisation, (European) Centres for Disease Control and Prevention), and the body of peer-reviewed scientific papers.
The paper literally refers to WHO and CDC advice as "scientific evidence".
It's ludicrous. The whole thing is thinly veiled opinion piece.
It boggles my mind how far "science" as a term has been degraded and driven 8 feet under.
Lockdowns were never an option because the Swedish constitution guarantees free movement for citizens; the government cannot legally enforce a lockdown. The lack of lockdowns was not a result of "following the science", but rather a non-decision dictated by existing policy.
"The decision to provide end-of-life care to many older adults is highly questionable; very few elderly have been hospitalised for COVID-19. Appropriate (potentially life-saving) treatment was withheld without medical examination, and without informing the patient or his/her family or asking permission. [...] there was only limited public outcry in Sweden when this came out, the common narrative being that those in care homes are expected to die soon anyway. [...] Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives."
This is quite shocking. I didn't think this would be possible in a country like Sweden.
In the early stages of the COVID-19 pandemic 9 out 10 deaths in Sweden was on persons over 70 years of age and half of them lived in a nursing home. I'm not sure what the current statistics says but probably within the same ballpark.
This is why Sweden has had a such a high death toll, because of bad care given to the elderly.
One big problem is that nursing homes in Sweden is often run by the kommun (city) whereas the hospital is run by the landsting (region), kommuns lacks the medical expertise on nursing homes to handle that kind of sickness, no oxygen or iv therapy.
And there has apparently been a reluctance to send patience from the nursing homes to the hospitals instead treating them at place, which increased the risk of dying.
Many elderly suffers from malnutrition in these nursing homes, malnutrition increases the risk of early death drastically.
I would also argue that it culturally exists ageism in Sweden, Swedish core belief is state sponsored individualism, you don't have any responsibility on others because your maximal individual freedom is guaranteed by the state, thus you basically dump the elderly on a nursing home never to be seen again, it is not your responsibility, it is the state.
Much of the Swedish society is very youth centric, it is not uncommon to find arguments a long the line, "it is good if the elderly dies off because they are holding us back".
This also explains why Sweden is so eager to jump on every new trend there is, progressivism in a nutshell.
> I would also argue that it culturally exists ageism in Sweden
In the supplements, they cite from "LARSSON, S.-O. & HARTIG, M. 2015. Ålderism (Ageism). In: (UPS), U. P. S. (ed.)":
"Sweden also ranks globally among the countries with the lowest regard to the elderly based on pre-pandemic surveys. Ageism, defined as prejudices or stereotypical perceptions based on a person's age and which can lead to discrimination, is a bigger problem in Sweden than in the other Nordic countries. When Swedish people are asked to rank the social position of different age groups in their country, the position of the elderly (70+ years) is ranked as the second lowest in the world. The elderly are also considered to have a much weaker position in society than young adults. This may be a consequence of prevailing individualism and rapid digitalisation and technological development, and weaker ties between the different generations (the family is not at the centre as in several other countries). In the Swedish society, aging is mainly regarded as a biological process of decay or decline, dehumanising the senior in the eyes of the rest of society, leading to marginalization and discrimination; considering the senior as a passive object."
One thing that I did not hear much of during the pandemic were the actual opinions of the elderly on the subject. Did they really want all of the measures that were taken?
This is not Sweden. While a lot of it rings true; like the strange mix of fierce indivudalism and collectivism in Sweden, and how we really did mess upp early elder care. I only have anecdata about elder care; my relative just now died in an one such home from brain damage + malnutrition the amount of care, happines and grit that was done to make her eat was heart warming. The same place hade been hit very hard by Covid, which ment they now had extreme proceedures in place that limited our visiting possibilities, that ment they had zero Covid cases during the peaks in 2021.
I think most of the care homes learnt after the first wave, at least I hope that my experience was representive.
I would argue that Sweden is not collectivistic at all.
In the golden years of the Folkhem (the people's home) Sweden was collectivistic to a larger extent, but because of the massive increase of living standards, a huge middle class emerged.
Core beliefs of the middle class is typically high individualism and materialism which usually translates to some form of liberalism.
Many, especially on the right, makes the mistake to equate high taxes with collectivism, but that is not necessarily the case, because it depends on how the taxes are collected and what the taxes are used for.
Today the Swedish's left argument for high taxes is to increase individual freedom, not collective freedom. The Swedish's right argument for low taxes is to increase individual freedom, not collective freedom, thus both the left and the right in Sweden is ruled by the same middle class and every big topic in Sweden since the at least 20 years has been of a middle class perspective.
Reducing society to high vs low taxes is one of the most extreme forms of individualism you can have.
While your personal experience is heartwarming, others here point to what I would describe state-approved cruelty of effectively euthanizing elderly who got seriously sick with covid earlier. That's not cool at all and even if now things are different its a right thing to point to these widespread failures that caused a lot of unnecessary death.
Few elderly patients who end up on ventilators for COVID survive, plus the process is very painful and causes permanent damage if you survive. So morphine actually sounds like a pretty good way to go, assuming there's some form of informed consent.
The problem was that there were cases were consent was not given and of healthy 70 year olds having to fight for ventilators at least in the beginning. From what I understood a lot changed when people realized what was happening in June 2020, the paper is pretty vague about this it talks mainly about the first half of 2020.
> state-approved cruelty of effectively euthanizing elderly
Unless I got the discussion completely backwards, the point here was that these homes are not run by the state. They are either private or by small municipalities, and are not really intended to provide medical care in the same way as hospitals do.
There are probably a lot of details here that's not at all obvious to an outsider of the system, exactly how the care is organized, paid for, and what medical facilities they can access, but I hope that they can learn and improve from this so the next pandemic do not hit the elderly quite this bad.
That some other countries may or may not have been hit worse does not make it any better. This is not a competition.
That is a pretty extreme interpretation of the paper. That view is also not helpfull if you want to talk about the regional problems around Sweden, it has been mentioned in other comments here. The paper is just bringing up a discussion we have had since june 2020 in Sweden, I sure do not think we will not stop discussing it.
Right, but it's only barely lower than France, about half-way between Germany and France. And then there's the question whether France is a great comparison; if you compare Sweden to its closer neighbors Finland and Norway - it's much, much worse off; and even compared to the more densely populated Denmark it's almost twice as bad. At best, the numbers look mediocre for Sweden - and that's if you somehow make the case it's more comparable to France+Germany than, say, Norway or Denmark. But if you consider other Nordic countries as baselines, the results look terrible.
Put it this way: imagine somebody gave you the data for deaths for many of the nearby countries, and lots of information about them all; vaccination rates, age distributions etc. The only number missing is Sweden's death rate. Would you have guessed it correctly? or guessed higher? or lower? I definitely would have guesses lower, somewhere between 2 to three times too low. Frankly, even with knowledge that their lockdowns were lax I would not have expected this high a death rate; after all it's not like it was business as usual or anything - people were socially distancing.
I'd say comparing countries like this is fraught, but also that Sweden has an unexpectedly high death toll. Whether it's high in absolute numbers, and what exactly the cause is... who knows. The cause may well be largely unrelated to their policies; clearly the differences between countries in general are not at all easily explained by policy differences, after all. But I don't agree with your statement that it outright doesn't have a high death toll.
"Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives."
This is from the abstract, but as far as I could find, this is never mentioned in the actual text of the paper? Certainly there's no reference to "oxygen", "morphine", or "administer" on the linked web page. So I guessed this had something to do with "end-of-life care", which is discussed in Supplement 6. But I could not find any explicit reference to morphine or oxygen there or in the sources of the supplement, either.
Maybe it's in (Habib, 2020), but the link is broken.
> Yngve Gustafsson, professor of geriatric medicine at Umea University, noted that the proportion of older people in respiratory care nationally was lower than at the same time a year ago, despite people over 70 being the worst affected by covid-19. He expressed concern about the increasing practice of doctors recommending by telephone a “palliative cocktail” for sick older people in care homes.
> “Older people are routinely being given morphine and midazolam, which are respiratory-inhibiting,” he told the Svenska Dagbladet newspaper [5], “It’s active euthanasia, to say the least.”
Euthanasia requires the explicit desire of being killed, clearly expressed by the patient, normally with the family knowledge and after legal consultation that proves that there is excruciating pain are there is not a better alternative for treatment.
And this is killing a helpless person unable to defend his life or will, and blocking their relatives to help him/her in this task. And it was not exclusive from Sweden, probably.
"A 17 March directive to Stockholm area hospitals stated patients older than 80 or with a body mass index above 40 should not be admitted to intensive care, because they were less likely to recover. Most nursing homes were not equipped to administer oxygen, so many residents instead received morphine to alleviate their suffering."
From the perspective of someone living in Sweden: considering how the elderly care sector seems to be organised to extract as much privatised profit as possible, rather than to make efficient use of money to help the people in care, I am not surprised that the pandemic response was so uncaring.
I think it sounds worse than it is. The number of oxygen machines is limited and the chances of survival even with an oxygen machine are not good for elderly people. If your projections say that you will get a certain number of younger people that will also need an oxygen machine then it makes sense to reserve those machines, they have a much higher chance of survival when using an oxygen machine.
Not doing a proper medical examination on the other hand is irresponsible imo.
You're overlooking the fact that Sweden's policies encouraged the spread of COVID. It wasn't inevitable that so many people got COVID before the vaccine.
I think this slipped by mostly unnoticed because the heavily polarized debate climate didn't really permit admitting fault or mistakes, it had turned into a trench war mostly about on whose side you are on. Really toxic dynamic.
"This is quite shocking. I didn't think this would be possible in a country like Sweden."
None of us living here thought it would be possible either. These irrational procedures, and the fact that the social democrats have repeatedly been stating in no unclear terms that Sweden's biggest problem is the elderly/geriatric demographic "who provide nothing and just cost us a lot of pension money", is why people think the strategy was entirely deliberate.
I recognize most of the names of the authors. Thus I am not very surprised about their conclusions. Nothing is actually new in this article. It is mostly incoherent writing, with some conspiracy theories thrown in. The usual stuff that has been coming from these authors since the beginning of the pandemic.
And for those confused: this is not published in nature, but in an open access journal owned by nature: "Humanities and Social Sciences Communications". This is not a subsection of Nature, and is rather obscure. I find it unclear what kind of peer-review has been done, but it has certainly not been done well.
This is not some kind of scientific proof of the "Swedish strategy" being crime against humanity. Merely a oddly placed opinion piece.
A person's opinion can be predictable in advance (1) because they are closed-minded and not responsive to evidence or (2) because they are responsive to evidence and the evidence is clear. Presumably you're saying #1 rather than #2 is going on with these authors; could you be a bit more specific about why you think that?
I had a quick look at the paper and it didn't seem obviously "incoherent writing" to me. Could you be a bit more specific about what you found incoherent?
In the abstract the authors refer to professors being dismissed from the national health authority. But the also say this happened in 2014 and that the professors were rehired at the very prestigious medical university hospital Karolinska Institutet. That kind of references to seemingly incriminating facts without actually explaining how they affected the policies recommend by the public health authority is not a serious way of making a scientific argument.
I have a hard time believing the dismissed professors had dissenting opinions on the validity of lockdowns or facemasks already in 2014.
It seems like you're suggesting that the authors of this paper are trying to imply that those professors were dismissed because they might give unwanted advice about Covid-19, or to hide the fact that they were re-hired at the Karolinska Institute. But the 2014 date, and the rehiring, are right there in the abstract in the same sentence as the one that says they were dismissed:
"In 2014, the Public Health Agency merged with the Institute for Infectious Disease Control; the first decision by its new head (Johan Carlson) was to dismiss and move the authority’s six professors to Karolinska Institute."
I'm not sure how these facts are any more "seemingly incriminating" than "actually incriminating", since the things you say (and I agree) make them less worrying are given plenty of prominence right up front.
It looks to me as if the argument the authors are trying to make is something like this: "The government moved the national health authority's actual experts out of the way several years ago, with the intention of making the health authority less an impartial scientific body and more a political tool. That meant that when the pandemic came along, politicians were able to persuade this body to make recommendations that were politically convenient even though they were scientifically unsound."
It may well be that that argument is a load of bullshit; I don't know. But, right or wrong or Not Even Wrong, it doesn't depend on hiding the 2014 date or the fact that the professors were given new jobs, and it doesn't need the people involved to have had the clairvoyance to predict what specific inconvenient scientific advice the professors might have insisted on giving.
That's a conspiracy theory that simply makes zero sense from a Swedish political perspective. Exactly none.
They don't make that accusation explicitly in the article because it's so ridiculous.
1. It's not like the National health agency was a pain in the butt for the Social democratic government in 2014.
2. Professors at Karolinska institutet can make their voices heard if they want to. It's the most prestigious scientific institution in Sweden. Their roles as top academics are still to advice relevant authorities.
3. Why would politicians actively undermine their own scientific advisors? For what ideological reason? I simply see none *in this context*. If it was about national economy, gender, migration or environment it *might* make more sense. But national health policy? That's a totally apolitical question in Sweden 2014.
There's also a simpler explanation at hand: a change in the organizational structure. The health authority still relies on advice from researchers. Maybe the change was made to make the advisors *more independent* as they're not on the payroll of the people they are to advice. A general trend in public management the last decades has been to reduce inhouse staff and outsource expert competency, this is totally in line with that.
If anything the government listened too much to the expertise in early 2020. That's why they did not take action earlier.
Never assume malice when incompetency is a sufficient explanation.
>By scientific evidence, in the context of this paper, we refer to the advice of international authorities in infection control (including the World Health Organisation, (European) Centres for Disease Control and Prevention), and the body of peer-reviewed scientific papers.
Any further questions?
Advice of international authorities is taken as scientific evidence.
And now this piece of shit thinly veiled opinion piece gets echoed and propogated furher as "peer-reviewed scientific paper published in Nature" right here in this very thread.
No one is calling it a "peer-reviewed scientific paper published in Nature" in this thread. The only person who mentioned Nature in this thread did so exactly to point out that this paper isn't published in Nature but in another journal somehow associated with Nature.
> And for those confused: this is not published in nature, but in an open access journal owned by nature: "Humanities and Social Sciences Communications".
Worth noting for those unfamiliar with academic publishing, "open access" does not necessarily mean anything for what it takes to get published. It's "open read" not "open write".
Yeah, I didn't mean open access as an insult. I just included it for description. Sorry for the confusion. I have published open access before, so I would be equally guilty in that case.
Isn't it just wonderful when the country we most hate for having implemented different covid policies to the suggested by the establishments of all of the countries in the West, coincidentally, is also morally terribly evil, they were giving end-of-life treatment when unnecessary!
The Swedish government does not consider that it followed significantly different policies from most other developed countries. They just implemented various policies at different times, which is true of every country depending on their phase of the pandemic. There were a lot of unknowns early on, and even countries that followed very similar policies often had very different outcomes depending on their demographics, geography, etc. The early differences in approach in Sweden are greatly overblown.
I'm sure there were situations in Swedish hospitals, in particular around Stockholm during the early stages of the pandemic, were patients were not given appropriate care because of the enormous pressure from COVID. No doubt this increased the number of deaths.
Did this happen because politicians and officials in Sweden despise the scientific method? No.
The initial calls to lockdown were justified with these projections, not with how many COVID deaths Sweden would have relative to neighboring countries.
Thirdly, not instituting a lockdown meant Sweden had far fewer limitations of civil liberties, and fewer adverse lockdown-related health and socioeconomic damage. For example, forcing a million young people to forego in-person schooling for a year would have done enormous damage to education:
Not to mention the harm to development from foregoing summer jobs, in-person social interaction, etc for one or two years.
The claim that lockdowns were appropriate doesn't even begin to contend with the harm from lockdowns. It focuses on COVID deaths single-mindedly, when it's a policy that affects every facet of society and daily life.
Whether the article is accurate or at least reasonable I don't know, however this criticism smells fishy - the kind of damages you're ascribing to the lockdown Sweden did suffer from, and not dramatically less so than nearby countries AFAIK. For economic indicators at least the data is available, and IMHO clearly shows Sweden was not unusual, e.g. https://www.statista.com/statistics/1274468/gdp-per-capita-n...
Suppressed human interaction and stress causes harms, I'll postulate to that - but clearly even without any government intervention at all the pandemic will see to that. Whether formal social-distancing measures make that worse is not obvious; they could even conceivably make it better (if coordination helps pick those that work best and reduces their overall length, for instance); and surely the details of the measures, including timing and duration, matter.
Ascribing pandemic related damages to lockdowns is wrong. Now, that doesn't mean lockdowns are always harmless, nor that this article is sane; but let's not delude ourselves that it's obvious "lockdowns" in general are terribly harmful, by comparing them to a false baseline of pre-pandemic normality.
>>For economic indicators at least the data is available, and IMHO clearly shows Sweden was not unusual, e.g.
Economic indicators over shorter time spans can't reflect long-term harm.
Tens of thousands of business closures, and elevated deficit spending to make up for the loss of private income, is going to show up in GDP statistics over a very long period of time.
You're correct that sheltering and social distancing behavior manifests in a lockdown-free society as well, but it will be 1. less prevalent (if not, what was the point of the lockdown) and 2. more intelligently applied based on the diverse set of circumstances found in the population.
With respect to point 2, a lockdown is a one size fits all solution that treats an elderly person and a young person the same, despite COVID posing a 1,000 times greater risk to the former than to the latter.
A lockdown precludes creative ways of minimizing COVID risk, like having social gatherings in venues with better ventilation, or only with people in a low-risk demographics, because again, a one-size-fits-all solution cannot be adaptive/intelligent the way individuals can.
A lockdown rule, being rigidly preset, can't know when a young person is facing drug abuse problems, and faces far greater risk from social isolation than from COVID. The US saw a massive spike in fentanyl overdose deaths in 2020, showing the steep cost of social isolation - which lockdowns exacerbate - for public health.
People when left to their own devices are able to make judgments based on their individual circumstances, and this latitude is impeded by lockdowns. The potential harm from this is simply ignored by the authors.
Mass business closures would show up in GDP stats fairly quickly, i.e. be visible by now. Regardless, we need to compare to the appropriate counterfactual; you're still listing a bunch of bad things that happened, but implicitly comparing those to some world where the pandemic never happened - but it did happen, so that's not valid; you need to tease out how much of those downsides are due to "lockdowns" specifically. There's just not a lot of clearcut evidence showing lockdowns actually were worse than the alternative - self-imposed lockdowns, or pre-vaccination mass outbreaks. Some countries suffered more; others less; but I can't see a trend (maybe somebody can, but at least a few papers on the topic are clearly biased, which doesn't help).
For instance When you ascribe Fentanyl overdose deaths to lockdowns, that's a mistake. Some of those are pandemic related, sure - but not necessarily the formal lockdown bits of it. Social distancing was going to happen no matter what; as was economic disruption and huge amounts of stress - and those factors may well increase the likelihood of overdose - but they would have applies with or without lockdowns. Furthermore, the huge number of ODs existed prior to the pandemic too - https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/... - lists the year ending in April 2021 as having 28.5% more deaths than the year ending in April 2020; and fentanyl OD deaths had been rising consistently for years up to that point too, i.e. it's not reasonable to assume they wouldn't have risen even without without covid and without lockdowns. Some of that rise was due to pre-existing trends, some of it due to covid - and perhaps very little due to lockdowns; especially if the alternative to lockdowns was even more deaths and social upheaval leading to "voluntary" economic shutdown. It's perfectly plausible lockdowns caused some of those deaths; yet it's also possible they prevented yet more OD deaths too. And if Fentanyl OD's were due to lockdowns, you might expect their timing to be correlated with them, or that states with more and stronger lockdowns have higher rates - but I can't find any evidence of that - can you?
Furthermore, let's talk about that word "lockdown", which you describe as being rigidly present - well, 0% of the world's countries had rigid lockdowns for the duration of the pandemic. Some had long, very mild non-pharmaceutical interventions (including some in Sweden!). Some had occasional harsher measures, but with many long pauses in between. We might as well call these "policies", because that better represents just how diverse all these measures were, and because it doesn't prejudice the reader into thinking these measures were all particularly harsh. Is a mask-mandate for shops a lockdown? How about for public transport? How about a max-occupancy for, say, a theater? Or school closures for over 16s? How about vaccine requirements for restaurants? Or vaccine passports for large gatherings? Or non-binding work-from-home advice? ... even when in practice major firms enforce it?
And even that belies practical complexities - I sure get the impression that most places, for most of the duration of the pandemic did not actually police many covid-restriction-violations very harshly. But that too will have differed from place to place, not to mention populations differ due to culture and habits and how any given restriction interacted with other restrictions.
We can't just throw all these policies in one big huge box labelled "lockdowns", give it a good shake, and expect meaningful data to emerge: that's classic garbage in, garbage out. Some of the policies were surely more effective than others; and some more harmful. But which policies?
If that weren't bad enough; clearly various countries had waves of differing intensities at different times, largely not due to anything the government was or was not doing. And governments deal with worse situations using the tools they have - including restrictions. But that raises the question of causality, too - in places that suffered more from social distancing and more from covid, which variable caused what change in which other variable? When we see "high death rate", what we _don't_ see is how high it _would_ have been with different policies (such as no restrictions). It's perfectly plausible that a country had excellent policy, including harsh lockdowns, real lock-down related damages, and high death rates - all at once! Because the alternative might have been much worse; and _that's_ hard to measure; we can't do randomized controlled trials on entire countries.
>>Mass business closures would show up in GDP stats fairly quickly, i.e. be visible by now.
Not when the state engages in deficit spending to make up for the lost income. That deficit spending will impact productivity over a very long period of time.
>>Regardless, we need to compare to the appropriate counterfactual; you're still listing a bunch of bad things that happened, but implicitly comparing those to some world where the pandemic never happened - but it did happen, so that's not valid; you need to tease out how much of those downsides are due to "lockdowns" specifically. There's just not a lot of clearcut evidence showing lockdowns actually were worse than the alternative - self-imposed lockdowns, or pre-vaccination mass outbreaks.
Obviously lockdowns increased sheltering-at-home/social-distancing behavior. If they didn't, there would have been no need to institute them.
>>Some countries suffered more; others less; but I can't see a trend (maybe somebody can, but at least a few papers on the topic are clearly biased, which doesn't help).
Here's a good meta study on the costs and benefits of lockdowns:
The conclusion is that the net effect of lockdowns was enormously negative.
>>Furthermore, let's talk about that word "lockdown", which you describe as being rigidly present - well, 0% of the world's countries had rigid lockdowns for the duration of the pandemic.
The definition provided in the meta-study linked above is:
>>The term “lockdown” is used to generically refer to state actions that imposed
various forms of non-pharmaceutical interventions. That is, the term will be used to include mandatory state-enforced closing of non-essential business, education, recreation, and spiritual facilities; mask and social distancing orders; stay-in-place orders; and restrictions on private social gatherings.
Of course lockdowns exist on a spectrum, from most all-encompassing, to least.
>>And even that belies practical complexities - I sure get the impression that most places, for most of the duration of the pandemic did not actually police many covid-restriction-violations very harshly.
Of course, this is all very complex, but from what I've seen, the evidence suggests that the harm from non-pharmaceutical interventions that limited the right to free association and movement did massively more harm than good, even ignoring the harm to civil liberties.
>>It's perfectly plausible that a country had excellent policy, including harsh lockdowns, real lock-down related damages, and high death rates - all at once! Because the alternative might have been much worse; and _that's_ hard to measure; we can't do randomized controlled trials on entire countries.
Of course, and that is why being careful with which countries are being compared is important in trying to tease apart the effects of lockdown interventions specifically, as this analysis does:
The report you link is not a meta-analysis (at least not one I recognize). Also, meta-analysis is a freaking minefield: garbage in, garbage out rules the day - i.e. the quality of any conclusions is limited by how honestly and competently it was performed, and even then, errors in the underlying papers can cause significant undetected problems - and worst of all, because a meta-analysis is a big blender, it makes it harder to find real problems distorting the conclusions; there's just more to slog through. If you're really scrupulous and there's no other way, I get that it's a nice way to eke out a bit more statistical margin, but it's such a easily misused tool - if the topic is at all controversial, I personally wouldn't trust em for pretty much anything. But hey, this report doesn't seem to be such an analysis.
That lockdown report makes exactly the same kind of errors your earlier reasoning did (i.e. attribute costs to lockdowns, rather than the pandemic, and ignoring possible benefits); I think the author is biased and decided not to follow the evidence, but rather to collect whatever arguments he can to arrive at his forgone conclusion. Notably, he spends lots of time trying to argue that the benefits of lockdowns were actually due to voluntary social distancing, but fails to do the same for the costs. The article smells like motivated reasoning - and given a topic that's so utterly impossible to study in isolation of course you can always find legions of reasonable sounding arguments either way. Also, the author is fairly blase in dismissing epidemiologists, which he is notably not - probably because expert opinion doesn't agree with him. And of course - if you define away the benefits to zero and assign all the costs to this account - hey, then the cost/benefit looks bad. But the devil in is the details, an that report makes no case as to why his particular way of accounting is any better than anybody else's.
I meant to leave it at that, but that paper is so bad, I can't help myself: Like, what's up with Table 2: that's a classic case is intentionally confusing correlation and causation (and it's so egregious the paper's author tries to come up with some flimsy excuse for it) - countries that have worse outbreaks will choose to have greater stringency, but of course he literally makes the argument that because this is true, lockdowns don't work. Say what? What a hack. If the author were honestly trying to tease out subtle causes and effects rather than merely ranting along his preconceived lines, he would never have included BS like that as part of his argument.
And if you google the guy - he's clearly been willing to lie with statistics before, including in a court case about same-sex marriages. This paper: same old, same old.
>>That lockdown report makes exactly the same kind of errors your earlier reasoning did (i.e. attribute costs to lockdowns, rather than the pandemic, and ignoring possible benefits);
The lockdown report teases apart the costs of lockdowns from those of the non-lockdown-related effects of the pandemic, and also looks at the benefit of lockdowns.
I don't think you're making a genuine effort to appraise it, making it pointless for me to engage in this.
I listed specific weaknesses in the paper you haven't addressed, so if there's anybody here arguing in bad faith: look in the mirror.
Additionally, note that it's trivial to google something like "lockdown effectiveness" in a private-mode window to escape your bubbel; and you'll see there are tons of papers arguing either case. Beyond it's technically poor analysis, it's also not representative of expert consensus; nor is the author an expert in the field, nor does he honestly portray expert opinion.
>>I listed specific weaknesses in the paper you haven't addressed, so if there's anybody here arguing in bad faith: look in the mirror.
I'm not going to evaluate your claims more closely when I see very elementary mischaracterizations of the paper in your initial comments, showing you didn't make a genuine effort to appraise it.
> People when left to their own devices are able to make judgments based on their individual circumstances
The pandemic also revealed that when left to their own devices, people make judgements based on their own individual circumstances without any consideration whatsoever given to the circumstances of others. People were having COVID parties in an effort to intentionally spread the disease -- that should tell you everything you need to know about an individual's capacity to think in terms of public health.
> like having social gatherings in venues with better ventilation, or only with people in a low-risk demographics, because again, a one-size-fits-all solution cannot be adaptive/intelligent the way individuals can.
The idea that we can let young people do whatever they want while isolating and protecting the old and vulnerable has always been false in our society. Many vulnerable people died as a result. It's created paradoxes where we send kids to school because they are not vulnerable; meanwhile their teachers are in fact vulnerable and have predictably died at a frequency that has created teacher and substitute shortages.
> The US saw a massive spike in fentanyl overdose deaths in 2020, showing the steep cost of social isolation - which lockdowns exacerbate - for public health.
Fentanyl has been a problem long before the pandemic, and many of the places that are most affected by increased fentanyl deaths over the last 2 years have imposed the least restrictive lockdown measures [0]:
Florida, a state which advertises itself as the state of freedom, and whose governor has positioned himself as an anti-lockdown champion, has the worst fentanyl deaths in the entire nation. So I don't know how much you can say about the causation between lockdowns and fentanyl overdoses.
One demographic that has seen the highest increase and absolute rates of fentanyl deaths has been African Americans, particularly young men and teens. If your contention is that fentanyl is a drug of despair, why are you assuming lockdowns are the source of that despair? During the summer of 2020, African Americans (and Americans of all backgrounds) highlighted one of the most pressing concerns in their community: police violence against black men and teens. Have you considered this despair as a possibility for the increase in overdose deaths (particularly considering many of the states hit hardest have very high black populations)?
As I expressed in my other post, your link is one of those studies which focuses mostly on the impact on children. Here's a larger study on the results from Sweden:
Many countries closed schools during the pandemic to contain the spread of SARS-CoV-2. Sweden closed upper-secondary schools, while lower-secondary schools remained open, allowing for an evaluation of school closures. This study analyzes the impact of school closures on the spread of SARS-CoV-2 by comparing groups exposed and not exposed to open schools. We find that exposure to open schools resulted in a small increase in infections among parents. Among teachers, the infection rate doubled, and infections spilled over to their partners. This suggests that keeping lower-secondary schools open had a minor impact on the overall spread of SARS-CoV-2 in society. However, teachers are affected, and measures to protect them could be considered.
The point that needs to be made is that no matter how immune children are, when teachers are dropping dead or even just getting sick at a high rate without the ability to find replacements, it's difficult to operate a school normally, no matter how much everyone wants to.
>>This suggests that keeping lower-secondary schools open had a minor impact on the overall spread of SARS-CoV-2 in society.
But you're disagreeing with that conclusion, and suggesting that the increase in COVID deaths amongst teachers, from a very small number, to a higher, but still very small number, would have caused more social harm than the harm of shutting down in-person schooling, which we know has been enormous:
"30-40 percent of minority and low-income students weren’t learning during lockdowns"
> suggesting that the increase in COVID deaths amongst teachers, from a very small number, to a higher, but still very small number, would have caused more social harm than the harm of shutting down in-person schooling
First, lower school students, or as we would call them middle school students, have a much lower rate of spread compared to 18 year olds in high school. The age brackets here are a little off, but it shows the effect [0].
But more importantly, what I've said in several posts now is that you are presenting a false dichotomy, which another poster points out you in your fentanyl argument as well. The choice was not "close schools" or "keep schools open". The choice was "How do we teach and keep everyone safe". Keeping schools open in various parts of the country and failing to implement proper safety measures resulted in tragic losses of brilliant young teachers who didn't have to die. Your feelings about the magnitude of the Sweden results notwithstanding, they still show increased risk for teachers; the case of Georgia where dozens of young teachers and school staff have died in such a short time, leading to shortages and closures out of necessity rather than caution, shows how COVID can easily disrupt the entire school system, despite students not transmitting the virus.
> "30-40 percent of minority and low-income students weren’t learning during lockdowns"
A lot of that has to do with the inequitable distribution of resources and access to things like wifi, computers, and quiet spaces for study. We have been advocating for funding for these things for a long time, for precisely this reason. The factors that cause minorities and low income students to have trouble learning during the pandemic are the very same reasons they struggle during normal times. Remember school lunch debt is a thing. Do you think hungry students learn well in the classroom?
It's really quite astounding to me that some of the loudest voices decrying school closures during lockdowns will be the ones standing in the way of increased support of the kind that would alleviate these inequities.
This is exactly the dichotomy many teachers unions forced, as they demanded not more safety measures for in-person schooling, but school closures and remote learning.
>>Keeping schools open in various parts of the country and failing to implement proper safety measures resulted in tragic losses of brilliant young teachers who didn't have to die.
This is entirely speculation, while you demand extreme rigor from me when I suggest a causative link behind the surge in drug overdose deaths in 2020 and the lockdown policies that massively exacerbated social isolation.
>>A lot of that has to do with the inequitable distribution of resources and access to things like wifi, computers, and quiet spaces for study. We have been advocating for funding for these things for a long time, for precisely this reason.
So you are admitting that teacher's unions knew that this would happen in the event of school closures. The teacher's unions' behavior was completely inexcusable and they were clearly not advocating for children.
> This is exactly the dichotomy many teachers unions forced, as they demanded not more safety measures for in-person schooling, but school closures and remote learning.
Not in my experience, no. We've asked for all measures of all kinds, and have been met with blanket "no's" in many places.
> This is entirely speculation, while you demand extreme rigor from me when I suggest a causative link behind the surge in drug overdose deaths in 2020 and the lockdown policies that massively exacerbated social isolation.
I had specific people in mind when I wrote that sentence. And I'm not demanding extreme rigor, I just want to see the causative link. Still yet to see it.
> The teacher's unions' behavior was completely inexcusable and they were clearly not advocating for children.
First of all, the initial round of school closings was not at the behest of teacher's unions, it was an almost coordinated movement across the entire country and in many industries. Very hard to put school closings at the feet of teachers unions. Secondly, teachers unions advocate for teachers, not children. Children have their own advocates in teachers themselves, who in fact advocated the strongest for children during this time. Very strange this effort to paint teachers as somehow anti-children when they literally devote their lives to kids at great personal cost to themselves.
>>Not in my experience, no. We've asked for all measures of all kinds, and have been met with blanket "no's" in many places.
I find that extremely hard to believe, as pressure from teachers unions successfully kept schools closed for over a year in many jurisdictions. The political cost to political leaders, and welfare costs to society, of simply accepting some demand for more safety measures in schools would have been far lower than keeping schools closed altogether, yet the latter is what happened.
>>I had specific people in mind when I wrote that sentence.
What do you mean? You made an allegation of a causative link, with no evidence provided beyond an anecdotal correlation.
>>The pandemic also revealed that when left to their own devices, people make judgements based on their own individual circumstances without any consideration whatsoever given to the circumstances of others.
Of course there are exceptions to every rule, but generally people adjusted their behavior based on rational risk benefit assessments:
>>Atkeson (February 2021) then used the same model with a simple behavioral
adjustment that allowed individuals to change behavior in light of the value of Rt
.
>>The new forecast of daily deaths is shown as the blue line in panel (b) of Figure 2.
Adding the single behavioral response completely changed the model’s predictive
power. The model now tracks the actual progression of the daily deaths very closely.
In correspondence with Atkeson he provided the reason for this result:
The intuition for this result is simple. If new infections and daily deaths from the
disease grow too high, people take costly efforts to avoid interaction and thus slow
disease spread. Likewise, if the prevalence of the disease falls toward zero, then
the demand for costly disease prevention efforts also falls towards zero, and so the
>>–
>>disease will come back unless the population has already achieved herd immunity
measured at pre-pandemic levels of behavior.
Regarding this:
>>The idea that we can let young people do whatever they want while isolating and protecting the old and vulnerable has always been false in our society. Many vulnerable people died as a result. It's created paradoxes where we send kids to school because they are not vulnerable; meanwhile their teachers are in fact vulnerable and have predictably died at a frequency that has created teacher and substitute shortages.
Young people should take priority over the old. This is not acceptable:
"Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020"
And for what? The lockdown proponents projected 96,000 COVID deaths by July 1st 2020 in Sweden without a lockdown. The real number was approximately 20 times lower, at 5,400, the vast majority the elderly.
Is robbing a million young people of a year of their development worth maybe reducing this 5,400 death toll? I think clearly it's not. You need to consider the damage done by lockdowns, not just by COVID.
Just this alone makes the whole exercise unacceptable:
"30-40 percent of minority and low-income students weren’t learning during lockdowns"
And the premise of your argument - that young people being able to live normally was such an unacceptably high risk to those older than them that it should have been forbidden - is very tenuous, with some findings suggesting that there was very little COVID spread through schools:
"Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools "
>>Fentanyl has been a problem long before the pandemic
I never implied otherwise. My only comment was on the spike in deaths.
>>and many of the places that are most affected by increased fentanyl deaths over the last 2 years have imposed the least restrictive lockdown measures [0]:
Alaska had a stay-at-home order, and in any case would have been amongst the most affected by the lockdowns, as it severely impacted travel between Alaska and the continental US. I don't see anything in that list suggesting that less locked down states saw a bigger spike in fentanyl deaths. In your list, all had stay-at-home orders:
And all of them had restrictions that persisted long after the stay-at-home order was lifted. Which of those states didn't shut down in person schooling?
>>Florida, a state which advertises itself as the state of freedom, and whose governor has positioned himself as an anti-lockdown champion, has the worst fentanyl deaths in the entire nation. So I don't know how much you can say about the causation between lockdowns and fentanyl overdoses.
Completely irrelevant to my point, which again, is about the spike in fentanyl deaths. Yes Florida has for a long time a massive drug problem, probably due to being the largest gateway for drugs entering the US.
Obviously this massive spike in fentanyl deaths is due to behavioral changes relating to the pandemic. And by far the behavioral change most likely to have contributed is social isolation, which is a known risk factor for drug use. You can't simultaneously argue that people are not risk averse enough to be left to their own devices, and thus we need lockdowns, while arguing that lockdowns did not contribute to the spike in fentanyl deaths through their impact on behavior.
>>One demographic that has seen the highest increase and absolute rates of fentanyl deaths has been African Americans, particularly young men and teens. If your contention is that fentanyl is a drug of despair, why are you assuming lockdowns are the source of that despair? During the summer of 2020, African Americans (and Americans of all backgrounds) highlighted one of the most pressing concerns in their community: police violence against black men and teens. Have you considered this despair as a possibility for the increase in overdose deaths (particularly considering many of the states hit hardest have very high black populations)?
The spike in fentanyl deaths was seen in all demographics. And to me it's common sense that being forced to stay home, and prevented from socially interacting, is going to be a far more likely source of despair, than some perception of police brutality stemming from the video of George Floyd's death.
I don't see how you are so easily dismissing the damage that lockdowns/social-isolation can do to people. People being negatively affected by social isolation and economic decline is completely predictable. Social isolation in particular is known to massively increase mortality risk:
"Social Isolation: A Predictor of Mortality Comparable to Traditional Clinical Risk Factors"
Even George Floyd had lost his job as a bouncer at a club due to the lockdowns before his attempt to use a fake $20 bill led to the deadly police interaction that killed him.
Your arguments are very confusing to me, because on the one hand you are arguing that lockdowns are not good and that they should not have been done because of the damage due to social isolation and other economic follow-on effects.
But then you link to a post that argues that we didn't need to lock down, because people would have taken costly (what costs? They don't say afaict) measures to lock themselves down anyway. I mean, take the passage you linked. What is this supposed to show? They have one model that is unreasonably bad, and then they refine it so that it is more reasonable, and then they show it better tracks the data.
The intuition for this result is simple. If new infections and daily deaths from the disease grow too high, people take costly efforts to avoid interaction and thus slow disease spread.
So basically lockdowns. But how does this avoid any of the damage you're talking about? How do schools and businesses stay open under these circumstances, where everyone has decided independently on their own volition to isolate?
> Young people should take priority over the old.
Yes, I'm a teacher so I'm not going to argue with you there. I spend a lot of time putting children first. But this line of reasoning always seems to forget the fact that there's a lot of old people involved in teaching children. The people who demand to keep schools open usually seem to stop short of demanding that teachers are protected. Let's look at your linked study for instance. This study shows that they had a successful start of the Fall 2020 semester in North Carolina. How did they do it?
In weekly superintendent meetings, several key contributors to success were noted: daily screening of students and staff, high rates of mask wearing adherence for children and adults, transparency in publicly reporting confirmed SARS-CoV-2 infections (eg, via Web site), efficient contact tracing, close collaboration with local health departments, regular updates with staff and principals to encourage adherence and report secondary transmission cases or any breaches in safety protocols, detailed schedule for all aspects of the school day to adhere to the 3W’s, definitive plans for the special needs community, and opening in the hybrid model of instruction. These refinements informed the 12 Principles for Safer Schools.
There was also full buy in from participating faculty, and plenty of training and education. During the period of Aug-Oct 2020 in North Carolina, community spread in general was low. It's true that schools are safer than many places if the proper precautions are taken. But that goes out the window when community spread is high. This distinction has been lost on many. This is a far cry to the environment of 2021, when community spread was quite high and parents were demanding teachers back to school in front of mask-less, unvaccinated children.
Look what happened in Georgia at the beginning of their school year:
The average age of the 42 teachers on this list who have died is 46 years old. The youngest was in their 20s. I don't know if this needs to be said, but dozens of young teachers do not usually die before the school year starts. There's a substitute teacher shortage [2], a bus driver shortage [3], school closures due to staffing shortages (not even COVID) [4], and yet people are out there demanding that this system be fully operational for their kids, immediately. That's not normal, and young people cannot expect normalcy given the above.
Whatever aggregate statistics you have about this situation, what they will fail to note is that even a single teacher death can throw an entire school and even a district into disorder in this environment. Because there are no replacements. No one wants to sub. No one wants to be a teacher anymore so it's hard to hire. When one teacher goes down then you have to tap unqualified people to teach a subject they aren't used to, and everyone is already oversubscribed. I mean, you're so worried about student outcomes, what happens to outcomes when teachers die and they are replaced with clueless substitutes? That's not a good learning environment either.
> My only comment was on the spike in deaths.
Right, but you immediately go to the idea that it's a spike due to despair from lockdowns. But if fentanyl has been a problem for a long time, maybe it's due to other reasons. For instance, the report you linked puts forth the notion that covid disrupted supply chains, leading to an increase in supply of tainted fentanyl batches, leading to a spike in deaths for people who potentially had already been using fentanyl before any lockdowns. So how would their deaths be due to despair at lockdowns?
> And all of them had restrictions that persisted long after the stay-at-home order was lifted. Which of those states didn't shut down in person schooling?
That's not the point, the point is that if loneliness due to lockdowns is causing fentanyl related deaths, then why are the states affected the most in the South or a border state? Like you said, Florida is a gateway for that stuff, so what if it's just that supply and opportunity increased, it comes over the border and affects those states most, but then it's also distributed across the country so it'll have an effect everywhere. Where is the connection from loneliness to deaths? You just have not shown it conclusively.
> Obviously this massive spike in fentanyl deaths is due to behavioral changes relating to the pandemic. And by far the behavioral change most likely to have contributed is social isolation, which is a known risk factor for drug use.
No, not obviously, that's the whole point here. None of this is obvious. You say "by far" and "most likely" with such confidence, but I am not as confident as you, and I don't know where you get your confidence from because it's not reflected in the articles you've posted as evidence for your positions.
What about the other risk factors, and what's the interplay between those and the pandemic? Such as for instance, would someone's family member or friend dying due to COVID correlate to an increase in drug use? How does that compare to someone being lonely and isolated? What about someone who is feeling isolated and then their family dies? Did they start drugs because they were lonely or grieving a loss? I just don't see any accounting for these nuances in your posts, and so I just have to wonder what makes you so sure of your position, that you speak in superlatives?
> You can't simultaneously argue that people are not risk averse enough to be left to their own devices, and thus we need lockdowns, while arguing that lockdowns did not contribute to the spike in fentanyl deaths through their impact on behavior.
I'm not arguing Covid didn't increase fentanyl related deaths of despair; I'm arguing that you didn't show causation. But while you mention it, you can't simultaneously argue that lockdowns are the result of despair related deaths, at the same time you argue that when left to their own devices, people will lock down on their own when confronted with COVID. Everyone around you voluntarily choosing to isolate themselves would have the same isolative effect on you as if the government told them to do it.
> Even George Floyd had lost his job as a bouncer at a club due to the lockdowns before his attempt to use a fake $20 bill led to the deadly police interaction that killed him.
I assume you said this in response to my having brought up the BLM protests of 2020, but to be clear those protests were not in fact about George Floyd; he was the catalyst, but 2020 was in response to a long string of murders. If you're trying to insinuate that lockdowns caused those protests by proxy, no. Cops murdering black men well before lockdowns caused those protests.
>>Your arguments are very confusing to me, because on the one hand you are arguing that lockdowns are not good and that they should not have been done because of the damage due to social isolation and other economic follow-on effects.
My argument is that people by and large make rational cost-benefit analyses, and pay the cost of sheltering-at-home/social-isolation if the benefit in COVID risk mitigation makes it worth it.
I alluded to that here:
>>A lockdown rule, being rigidly preset, can't know when a young person is facing drug abuse problems, and faces far greater risk from social isolation than from COVID. The US saw a massive spike in fentanyl overdose deaths in 2020, showing the steep cost of social isolation - which lockdowns exacerbate - for public health.
To summarize, maximizing COVID risk mitigation is not the appropriate strategy for every individual. Whether it is, depends on their situation/circumstances. Lock-downs are a cookie-cutter solution that cannot make these kinds of distinctions.
>>The people who demand to keep schools open usually seem to stop short of demanding that teachers are protected. Let's look at your linked study for instance. This study shows that they had a successful start of the Fall 2020 semester in North Carolina. How did they do it?
>>In weekly superintendent meetings, several key contributors to success were noted: daily screening of students and staff, high rates of mask wearing adherence for children and adults, transparency in publicly reporting confirmed SARS-CoV-2 infections (eg, via Web site), efficient contact tracing, close collaboration with local health departments, regular updates with staff and principals to encourage adherence and report secondary transmission cases or any breaches in safety protocols, detailed schedule for all aspects of the school day to adhere to the 3W’s, definitive plans for the special needs community, and opening in the hybrid model of instruction. These refinements informed the 12 Principles for Safer Schools.
It seems reasonable to assume that most of these measures would not impose significant harm to children, and thus would be perfectly appropriate to institute. Mask-wearing could harm children, due to its obstruction of communication and potential inhibition of social gathering and physical activity, and this would need to be seriously examined before the measure is mandated.
But school closures as a whole, which is the biggest point of contention, will absolutely harm children, yet teachers unions pushed for this for over a year in many jurisdictions.
>>Look what happened in Georgia at the beginning of their school year:
While this is obviously tragic, it is an ancedote, so these numbers cannot be generalized to all school districts. Moreover, there are far more likely vectors of transmission than exposure to students in schools. This study suggests that the vast majority of transmission occurs at home:
>>Whatever aggregate statistics you have about this situation, what they will fail to note is that even a single teacher death can throw an entire school and even a district into disorder in this environment. Because there are no replacements. No one wants to sub. No one wants to be a teacher anymore so it's hard to hire. When one teacher goes down then you have to tap unqualified people to teach a subject they aren't used to, and everyone is already oversubscribed. I mean, you're so worried about student outcomes, what happens to outcomes when teachers die and they are replaced with clueless substitutes?
A teacher dying is obviously damaging to students, and of course to the teacher themselves along with their family, but how could it possibly be more damaging to children than 30-40% of minority students not learning during the lockdown?
>>Right, but you immediately go to the idea that it's a spike due to despair from lockdowns. But if fentanyl has been a problem for a long time, maybe it's due to other reasons.
The spike, not the baseline, is due to despair. So fentanyl being a problem for a long time is not relevant to my argument.
>>For instance, the report you linked puts forth the notion that covid disrupted supply chains, leading to an increase in supply of tainted fentanyl batches, leading to a spike in deaths for people who potentially had already been using fentanyl before any lockdowns. So how would their deaths be due to despair at lockdowns?
This could also be another cause, but we know mental illness and substance abuse increased in 2020, so "bad batches" cannot explain the entire spike in overdose deaths, and a portion of the spike needs to be attributed to the behavioral changes that emerged in 2020, the most likely cause of which is pandemic-related measures.
Beyond an increase in drug use and a rise in the frequency of bad batches, there is the additional risk of isolation during drug use, which makes overdoses more likely to become fatal.
>>That's not the point, the point is that if loneliness due to lockdowns is causing fentanyl related deaths, then why are the states affected the most in the South or a border state?
One more time: I am not saying that loneliness is the sole cause of fentanyl use. I'm saying it's the cause of the spike in fentanyl use seen in 2020. You're not grasping my critique of your argument as you keep on referring to the higher levels of overdose deaths in the South/border-states.
>>Where is the connection from loneliness to deaths? You just have not shown it conclusively.
I can't prove anything definitively, but the correlation between fentanyl deaths and the pandemic makes it pretty obvious that there's a causative association. The effect of loneliness on the risk of substance abuse is also well documented:
>>No, not obviously, that's the whole point here. None of this is obvious. You say "by far" and "most likely" with such confidence, but I am not as confident as you, and I don't know where you get your confidence from because it's not reflected in the articles you've posted as evidence for your positions.
It's extremely obvious to me, based on what I have read and seen. A massive increase in social isolation, caused by COVID mitigation measures and efforts, is obviously going to cause enormous harm to mental health, and to normal healthy life habits, which will lead to exactly the results we've seen, with the spike in mental illness, substance abuse and obesity during the pandemic response era.
>>What about the other risk factors, and what's the interplay between those and the pandemic? Such as for instance, would someone's family member or friend dying due to COVID correlate to an increase in drug use?
Given 2.8 million people died in the US in 2019, it wouldn't make sense that the 385,000 COVID deaths, which only amounts to 13.7 percent of the baseline number, would have that profound of an impact on mental health and prevalence of substance abuse. We've seen the share of adults reporting anxiety/depression increase from 11 percent in 2019 to 41 percent in 2021:
That magnitude of a difference can't be reasonably explained by an increase in the death rate amounting to 0.1 percent of the US population.
>>I'm not arguing Covid didn't increase fentanyl related deaths of despair; I'm arguing that you didn't show causation.
Those arguing for mandatory behavioral modification have to prove it's safe. The onus is not on me to prove that the subsequent surge in mental illness, obesity, and substance abuse was caused by this mandatory behavioral modification. The onus is on lockdown supporters to prove that it wasn't. You have to prove that a highly distressing/disruptive intervention, that is forced on millions of people, is not going to harm them, before instituting it. And there are plenty of indiciation that it was in fact harmful.
>>But while you mention it, you can't simultaneously argue that lockdowns are the result of despair related deaths, at the same time you argue that when left to their own devices, people will lock down on their own when confronted with COVID.
You're oversimplifying my argument. I'm saying that people will generally make rational cost-benefit analyses that will lead to them taking the appropriate measures that minimize all risks that face them. For a person with substance abuse problems, the risk of social isolation that emerges from social distancing measures may outweigh the risk from COVID from not taking those measures, and they may choose to not socially distance as a result. These kinds of individualized responses are not possible with lockdowns.
>>I assume you said this in response to my having brought up the BLM protests of 2020, but to be clear those protests were not in fact about George Floyd;
They were triggered by the George Floyd video. The number of unarmed black people being killed by police is very small, and has decreased enormously over the last decade. More black people are killed in single days in Chicago by people other than police than the number of unarmed black people killed across the entire US over the course of a year by police.
> It seems reasonable to assume that most of these measures would not impose significant harm to children, and thus would be perfectly appropriate to institute.
And yet most of those measures are very expensive to implement, and in fact they are resisted by various groups. They don't want to do anything.
> While this is obviously tragic, it is an ancedote, so these numbers cannot be generalized to all school districts.
I mean, we're talking about an entire state here. It's more than an anecdote is an ever-growing list of obituaries. The shortages are not an anecdote, it's a systemic failure of which we can identify the cause. And the solution isn't "Let's just get back to school"
> Moreover, there are far more likely vectors of transmission than exposure to students in schools. This study suggests that the vast majority of transmission occurs at home:
Where the virus is contracted does not matter if the issue is that you don't have a teacher to teach the children. I don't know why this keeps getting lost. Let's pretend that everyone inside of a school is magically immune from covid. Schools have some special property that confers immunity while people are in the building. Even if that were true, if a teacher gets covid outside of school and can't come in to work, who is going to teach the class that day? Please just answer that question, keeping in mind there is a substitute and teacher shortage due to covid.
> how could it possibly be more damaging to children than 30-40% of minority students not learning during the lockdown?
The link you provided does not say that 30-40% of minorities students are not learning due lockdowns. That may be one aspect of it, but it also goes on to note that black and Hispanics were hit harder by the pandemic in terms of cases and deaths, which were due to not locking down certain industries (e.g. meat packing plants, where Hispanics are overrepresented and died at higher rates). I dunno about you, but if my mom died because her boss said she had to come in to work, I don't think I'd be able to learn no matter what the setting and access to technology.
This is again a very complicated and nuances topic you are laying entirely at the feet of the "lockdown" boogeyman.
> but we know mental illness and substance abuse increased in 2020, so "bad batches" cannot explain the entire spike in overdose deaths, and a portion of the spike needs to be attributed to the behavioral changes that emerged in 2020, the most likely cause of which is pandemic-related measures.
Thank you finally some nuance. So you now admit there are a number of factors, and the question before us is how much do they each impact the outcome. But then you again assert without evidence (the link you provided does not support your claim) that the "most likely cause" is pandemic-related measures (rather than the pandemic itself). I really think you need to start separating your opinions from evidence-based assertions.
> It's extremely obvious to me, based on what I have read and seen.
And it's not obvious to me. If you can't even provide me with proof of something that is "extremely" obvious to you, then I think it's incumbent upon you to question your foundational assumptions here. How is it that you have so easily dismissed the actual pandemic that his killed hundreds of thousands in the US and millions around the world as the cause of anu purported despair. Why do you think that restrictions (which your own links note were not even enforceable, and to the extent they changed behavior, the behavior actually would have changed regardless) are the thing that is causing all the problems in society?
> Given 2.8 million people died in the US in 2019, it wouldn't make sense that the 385,000 COVID deaths, which only amounts to 13.7 percent of the baseline number
One characteristic of covid is that while a majority of deaths are the elderly, it has caused some very untimely deaths, which are infinitely more tragic than a death after a life well-lived. Just take the Georgia teachers for instance. 40 seniors in nursing homes die all the time. That's not going to impact anyone aside from the immediate family, who honestly will largely carry on as normal the day after the funeral. 40 teachers from the same state dying in the span of weeks under the age of 50 just does not happen, ever, from any cause. This result causes extreme existential dread not just for the people who knew them personally but for millions in that profession around the country.
> Those arguing for mandatory behavioral modification have to prove it's safe.
> The onus is not on me to prove that the subsequent surge in mental illness, obesity, and substance abuse was caused by this mandatory behavioral modification.
Forget onus, how does one prove that something wasn't? Moreover, what you're asking for is inaction in the face of provable imminent danger. How do you prove an untested action will not harm people more than an unknown pathogen while the pathogen is rapidly spreading? How would that even work? It wouldn't, it would just lead to the pathogen doing whatever it wants while we try to prove our mitigation methods work.
So really the best we can do right now is to look back and see what harms mitigation measures caused, versus what harms the virus caused. And then we can use the magic of statistics to try and figure out what were the most important factors, and which ones were not so important. But nothing about this process is obvious to me at least, so I'm still mystified as to why this is so clear to you, yet you can't actually prove it to me. If you can intuitively see these things and know you are right in your heart, good for you, but that doesn't help the rest of us.
> For a person with substance abuse problems, the risk of social isolation that emerges from social distancing measures may outweigh the risk from COVID from not taking those measures
Okay, I agree, but you're still not addressing the fact that people social distanced on their own, as noted by your own supporting evidence. How do you imagine this playing out? What happens when customers at your work decide on their own they'd rather stay home than face the disease, business slows down so you get laid off, and you're stuck at home unemployed and lonely because your friends are all social distancing. Nothing about this scenario requires a mandated lockdown, it results in the same loneliness, the lonely person is still powerless to fix their situation, and none of it was caused by government intervention. This counterfactual is completely in line with all the evidence you have presented and it doesn't support your argument at all.
> They were triggered by the George Floyd video. The number of unarmed black people being killed by police is very small, and has decreased enormously over the last decade. More black people are killed in single days in Chicago by people other than police than the number of unarmed black people killed across the entire US over the course of a year by police.
I don't know what you're trying to say here. You're just minimizing people's stated reasons of grievance.
>>And yet most of those measures are very expensive to implement, and in fact they are resisted by various groups. They don't want to do anything.
Yet many school districts shut down in person schooling altogether. The notion that they'd be willing to acquiesce to this very extreme demand from teachers unions, but not much milder demands like those you mentioned, is hard to believe.
>>I mean, we're talking about an entire state here.
You can find an outlier state for any given statistic, so it is in fact an anecdote.
>>It's more than an anecdote is an ever-growing list of obituaries.
It's an anecdote.
>>The shortages are not an anecdote, it's a systemic failure of which we can identify the cause. And the solution isn't "Let's just get back to school"
There is no analysis done to see how much of that could be attributed to in-person schooling leading to COVID deaths among teachers, and the comparing the social/human cost of that to the cost of children missing out on in-person schooling for a year, because the teachers unions are interested only in advocating for their employees, not in genuinely searching out to find the best policy for the public interest.
They have already made their mind up on what the correct conclusion is, and they are just searching for arguments that could plausibly support it.
>>Even if that were true, if a teacher gets covid outside of school and can't come in to work, who is going to teach the class that day? Please just answer that question, keeping in mind there is a substitute and teacher shortage due to covid.
I don't understand why all in-person schooling has to be shut down because some teachers cannot attend class. There are still many teachers available that can do in-person schooling. Why not at least have them do in-person instruction?
>>The link you provided does not say that 30-40% of minorities students are not learning due lockdowns. That may be one aspect of it, but it also goes on to note that black and Hispanics
It says specifically that they were not learning via remote instruction. Here's a graph that lays it out:
So you're mischaracterizing what the linked page is asserting. It is absolutely claiming that remote education led to massive education losses for a significant fraction of minority students.
This is absolutely for the school shutdown position, which makes it unsurprising that you're not willing to accept the conclusions of that analysis, and are even mischaracterizing what they are.
The rest of your arguments are just rehashing points I've already rebutted, or more of the case of you demanding definitive proof from every conceivable indication of damage from lockdowns, while accepting every claim of harm from the absence of a lockdown.
>>I don't know what you're trying to say here. You're just minimizing people's stated reasons of grievance.
I'm not even commenting on their stated reasons, which are orthogonal to my point about what triggered the riots. I'm pointing out the fact that the riots were triggered by the George Floyd video. That's not a disputable fact.
But any fact that shines poorly on the lockdown, you feel compelled to dispute. This is the typical case when debating unionized teachers who argued, under the lockdown philosophy, that schools should be shut down for a year or more, in favor of the disastrous remote learning that led to so much educational loss for children.
> First of all, the comparison to other Nordic countries is inappropriate. Its population-weighted density is closer to the UK, and closest to Austria:
According to the linked article, the population-weighed density of Denmark is higher then Sweden.
Yes, you're correct. It identifies Denmark as an outlier:
>>In fact, in Western Europe, there is a striking correlation between population weighted density – which may influence both the speed of virus transmission and the amplitude of infection waves – and covid mortality per country (see map below). This correlation does not apply, however, to Denmark, which has a low covid mortality but an average population weighted density (3434).
I already admitted my mistake, so I don't understand why you're still being accusatory.
To make clear, I was incorrect in generalizing all the other Nordic countries as having a lower population-weighted density. But it's an outlier and I think the support for the broader point is still strong.
I don't understand what you're saying. The post you linked to makes a point to say that we should not compare Sweden to its Nordic neighbors because Sweden is actually closer in population weighted density to the rest of Europe. The article calls population weighted density the most fundamental of the arguments it uses to try and separate Sweden from its Nordic neighbors. The post calls the correlation between population weighted density and covid mortality "striking", I assume to emphasize it is a strong correlation. But then it just throws Denmark out as an outlier.
I'm sorry, but when your sample size is 4, you can't throw out one of them and call it an outlier because it doesn't fit the narrative. This sounds like classic cherry picking to me, especially when the narrative is one the author chose specifically to make a comparison favorable to their main argument! For all the submissions on HN decrying bad statistics, you'd think this kind of argument wouldn't fly here.
"We can't compare against the Nordic countries because they are not like Sweden, and we can't use population density because that's the wrong way to look it. Instead we look at population weighted density, and we throw out the one that causes our argument to fail. Then when we compare to Austria, look what a winner Sweden is!"
I understand that there's some merit to the line of reasoning you are presenting, especially population weighted density, but as far as the article goes, to just throw out Denmark as an outlier because to include it would refute the central argument of the article really puts it in a bad light.
Denmark is not just an outlier among the four countries. It's an outlier within all of Europe in terms of its correlation between COVID death and population weighted density. Denmark's counter-example alone is therefore not enough to discount the relationship between population weighted density and COVID risk in my opinion. Consequently, the other Nordic countries, having lower population weighted density than Sweden, make a poor set to compare Sweden to.
I disagree, even if n = ~40 you still need more justification to call Denmark an outlier. There's no accompanying analysis to support its rejection from the comparison, let alone an attempt to quantify exactly how much of an outlier it actually is. Especially when the title of your piece is "Sweden vindicated", you'd better do more than handwave.
Your response is pedantic. It is statistically an outlier.
"There's no accompanying analysis to support its rejection from the comparison, let alone an attempt to quantify exactly how much of an outlier it actually is."
There's no accompanying analysis to support its inclusion in the comparison, let alone an attempt to quantify exactly how comparable it actually is.
Claiming Sweden underperformed Denmark is also a far cry from claiming that Sweden underpeformed other Nordic countries as a whole, as the original article does.
Is it though? Because neither you nor the linked piece have provided any framework by which to call it an outlier. Calling something a statistical outlier has no meaning without statistics.
> There's no accompanying analysis to support its inclusion in the comparison
The case for its inclusion is the fact that it's a country in the region, and we're comparing countries in the region. You don't need a good reason to include it, you need a good reason to exclude it, especially when it's the only one excluded, and again, especially when the title of the piece contains the word "vindicated". Calling something an outlier and causally tossing it aside, especially when it contradicts your point is classic cherry picking.
>>Is it though? Because neither you nor the linked piece have provided any framework by which to call it an outlier. Calling something a statistical outlier has no meaning without statistics.
That's entirely false. The study provided the framework, which is a map and graph showing the countries of Europe and both their population weighted density, and their COVID mortality rates, respectively:
Among the Nordic countries, Sweden is the outlier because of the larger number of deaths relative to the population-weighed density. The Nordic countries are otherwise pretty comparable when it comes to demographics, household size and general culture.
> This Nordic cross-comparison is lazy and agenda-driven.
Nothing says "agenda-driven" like claiming that an incredibly complex comparison should be entirely based on "population-weighted density" and posting a blog titled "Judgment day: Sweden vindicated" that also regularly posts misinformation[1]. If you are going to critique an approach, you should at least not make your bias so blatant.
I imagine the motivation behind this paper was, it is embarrassing to the rest of the world that Sweden got it right about lockdowns and masks, so we mush punish them. Let's write a paper claiming they did something else unrelated wrong.
That paper could easily have been written about at least one COVID policy in every country on earth, but Sweden was singled out.
If you have a look at the background and affiliation of the authors, there is a perfectly reasonable explanation as to why the country of study is Sweden without having to resort to mildly conspiratorial thinking.
Not saying that there is no political nonsense going on related to the subject at hand. But this is (to a scientist in a different field) a well-authored article in a respectable journal. Thus I think it is a fair addition to a very complex debate that will likely continue among scientists long after the pandemic settles.
Edit: I may be wrong about the journal. Springer has a rather elaborate network of journals using their “brands” and it looks to me like this one is far from receiving the same level of editorial scrutiny that one would expect [1]. The hint may be “communications” in the name, possibly indicating that this is a more to be treated like a scientific opinion piece (still, far better than an op-ed) than anything else. It also appears to be in the area of humanities and social sciences rather than “pure” medicine for some reason; with a majority of the editorial board lacking relevant expertise [2]. Anyone more familiar with publishing in medicine, medical policy, etc. is more than welcome to chime in.
The “communications” branding has more to do with the prestige level and expectation of faster-paced short research notes. Usually opinion pieces are explicitly filed under a “perspective” track (vs review and original research track).
The hierarchy usually goes Nature, Nature Communications, Nature [field name] communications, then field specific nature-owned journals (which sometimes have higher status than the field specific communications journals)
More people died here and continue to die every week, yet our economy still took a big hit and important societal functions have still been harmed. In what way did we “get it right”?
20k deaths for a population of 10M in Sweden is 0.2% right? USA has had just under 1M deaths for 330M people or closer to 0.3%.
I'm not saying that Sweden did the totally right 100% perfect thing. But it seems to have done much less catastrophically horrible than many predicted at least as far as I can see.
I like what you’re doing here. Take a country like the United States with a horrible outcome and use them for comparison. More people died after vaccines than before in the United States. How does that happen?
One thing is absolutely clear: 1 million Americans never needed to die from coronavirus.
It's not clear to me the total deaths number is accurate in the US because the government was reimbursing hospitals for COVID treatment and paying for people's funerals who "died of covid". It incentivized people to list the cause of death as COVID even when covid didn't play a role in the death or was at best incidental to it.
Anecdotally this happened with the father of a friend of mine. He had cancer since before the pandemic and it became terminal after exhausting treatment options last year. As his condition deteriorated, they planned to move him to hospice, did a routine covid test and found he was positive. He died a few days later. He was going to die of cancer in days no matter what. He is counted among the million US covid deaths and the US government paid for a portion of the cost of the funeral.
What percentage of that million are cases like this? I don't know, but it is pretty clear it wasn't uncommon and in the context of your original comment I wouldn't call cases like this preventable deaths.
Excess deaths could just have easily been caused by people postponing medical care for other conditions. Hospitals were canceling elective procedures for example.
Nonsense. There are various reasonable ways to calculate a baseline and they all show large surges over the covid period (which correspond to reported covid deaths, btw).
Also, there are no winners, what are you even talking about?
Do you average deaths over the past 5 years? Or 10 years? How do you correct for population growth? How about age distribution? What if you had a flu pandemic and deaths were 5% higher 3 years? Correct for that or not?
and? do you have any proof of your claim that "It incentivized people to list the cause of death as COVID even when covid didn't play a role in the death or was at best incidental to it"? Are you saying doctors are personally getting some sort of kickback?
Besides my direct experience? It doesn’t require fraud this is the result of the loose requirements to get reimbursed under these temporary measures and the fact that COVID tests are a routine part of hospital admissions. For example to be reimbursed for funeral costs COVID only need be listed as a contributing cause and doesn’t need to be the primary cause of death.
"Better" in the sense that it makes them look worse, and some people prefer this version of events? Perhaps.
But if you compare across all of Europe by deaths per capita, they're near the best performers on the list (#13; #12 in continental Europe), and the only reason those specific countries look better is because they're the top three in continental Europe (they're also smaller countries; see below):
In particular, the UK, France, Spain, Belgium, Italy and Portugal all did worse, despite far more significant impositions on society.
It's also important to know that worldwide, there's a clear dependence of per-capita deaths on population (greater population -> greater deaths per capita):
And that Denmark has a population of ~5.8M, Norway 5.4M, and Sweden 10.4M. This alone should make you question any simple narrative involving interventions and outcome.
There's a recent large study in The Lancet, where they estimate 2020-2021 excess mortality, and compare these to reported Covid19 deaths. The study covers a large number of countries, but here I only look at your four.
Either the study methodology to estimate excess mortality has some problems with Denmark and Finland. Or, if the study is correct, the official numbers from Finland and Denmark are bad in estimating their own Covid19 deaths: Denmark underestimating by 3x, Finland underestimating by 5x.
Denmark tested way more than any other country in the world. They most likely have the most accurate picture of how many people actually died with covid
I'd strongly question their method of calculating excess mortality, look at denmark on https://www.euromomo.eu/graphs-and-maps and compare it to other countries
I would assume methodological flaws. Just by looking at the number of authors and the publication date, the authors simply did not have enough time to control for area-specific factors for 191 countries and 252 subnational units.
Finland reported 53949 deaths from all causes in 2019, 55488 deaths in 2020, and 57343 deaths in 2021. (The figure for 2021 is preliminary.) The total increase from the 2019 level in 2020-2021 is ~5000 deaths, and a large part of that is explained by aging population.
Societies and health care aren’t as similar as one might think in the Nordics. Sweden is surprisingly diverse, unequal, urbanized etc. It’s more “continental” than its neighbors in a lot of ways.
Sweden did not have a good response to the COVID pandemic. More people died than in many comparable countries, we can agree on these facts. But that the response was poor because authorities did not "listen to scientists" is a difficult claim to swallow.
Before 2020 the concept "national lockdown in response to a virus outbreak" simply did not exist. There were no consensus in the scientific world that a lockdown would be an effective measure to improve peoples health, all things considered.
If anything I think the Swedish weak response was an effect of listening too much to expert opinions and politicians not taking initiatives and making their own judgements.
Early in the pandemic there were many predictions made on number of deaths etc by some scientists. These models often overestimated the number of deaths/cases. Science is important but it's messy and it takes time.
Yeah but I do think there is merit in comparing Sweden to neighboring countries such as Denmark.
However, luck is also a factor that shouldn't be disregarded. If anything was learnt from the attempts of modeling the development of the pandemic it should be that the virus does not diffuse through the population in some idealized fashion. It's extremely messy and depends on local circumstances and sheer chance.
This can easily be confirmed by comparing different regions of countries. Despite similar regulations the variation is enormous.
Only if you ignore other factors like demographics and population density of population / population-weighted density.
Countries should be evaluated based on performance relative to doing nothing not relative to other counties in very different situations. Niger has a median age of 15.4, Italy has a median age of 45.5 they simply have vastly different ratios of the elderly etc.
For disease transmission it’s the average population density of the population not the country. Effectively the population density of each area * population in that area divided by total population.
So, assuming 3 areas 1,000 square miles with 2,000 people, 100 square miles with 4,000 people and 10 square miles with 8,000 people you do :
(2,000^2/1,000 + 4,000^2/100 + 8,000^2/10) / (2,000 + 4,000 + 8,000) = 468.8 people per square mile, not (2,000 + 4,000 + 8,000) / (1,000 + 100 + 10) = 12.6 people per square mile.
The reason is adding a huge area that nobody lived in (ex: 1 person across 1 million square miles) doesn’t change the calculation. (1^2/1,000,000 + 2,000^2/1,000 + 4,000^2/100 + 8,000^2/10) / (1+2,000 + 4,000 + 8,000) = 468.8 people per square mile
“Urban” Sweden is much different from other countries. For example, someone else urged us to compare Sweden to France. Yet Paris has a population density of 20000/km^2 versus Stockholm’s 4000/km^2. I’ve lived in places with both densities and one is considerably more “urban” than the other.
If you draw the border of Paris further and further out, I’m sure you can get the density as low as you want. Meaning: the density figure of a city says very little of how dense it is and says more about how far out into sparsely populated farmland the official city limit ends.
Go look at a Google street view of the far ends of Stockholm metro area…
Paris has a population density of 9,800/sq mi across 1,101.7 sq mi and an inner core of 53,000/sq mi across 40.7 sq mi.
Stockholm’s urban area of 11,000/sq mi across 147.35 sq mi, is comparable to Paris, but it’s inner core 73 sq mi is a much lower density 13,000/sq mi. Even if you assumed all those people lived in a 40 square mile “inner inner” core you still don’t get close to 53,000/sq mi.
Population density is indeed important, but averaging over whole countries gives the wrong impressions.
Covid was deadlier in urban areas. Compare rural regions, such as the ones bordering Norway and Sweden, and the mortality is pretty much comparable across the border. Slightly on the Swedish side, but well within what can be ascribed to random variability. That doesn't make the border closings look especially effective in retrospect. The virus doesn't care about borders.
> Sweden did not have a good response to the COVID pandemic. More people died than in many comparable countries, we can agree on these facts.
I do not agree. And you don’t provide any evidence to support your claim. This paper doesn’t either; it uses Norway as a single comparable country, and their reasoning is that it’s another Nordic country. As others have pointed out in this thread it’s quite dissimilar in many ways.
National lockdowns where a common strategy for outbreaks before 2020.
Spanish flu: “Social distancing measures were introduced, for example closing schools, theatres, and places of worship, limiting public transportation, and banning mass gatherings.”
And just to show how little had changed: “Wearing face masks became common in some places, such as Japan, though there were debates over their efficacy.[173] There was also some resistance to their use, as exemplified by the Anti-Mask League of San Francisco.“ https://en.wikipedia.org/wiki/Anti-Mask_League_of_San_Franci...
However, social distancing and quarantine was recommended by the Swedish health authority in the early stages of the pandemic. I refered to the society wide lockdowns, those kinds of measures were not applied (could not have been applied) in 1918.
What specific difference are you thinking of? The US had plenty of local lockdowns in 1918, including such things as school by phone. Mask mandates, closing or minimum 20 foot separation between tables at restaurants etc.
I agree it was a more local response, some locations closed bookstores others kept them open etc. But we only created the CDC in response to the Spanish flu, there simply wasn’t a national organization developed to handle pandemic response.
I don't believe there were enough telephone infrastructure to have school over phone for more than a very marginal part of the population in 1918. I'd like to be proven wrong.
> there simply wasn’t a national organization developed to handle pandemic response.
Exactly. But not only that, our technical and economic capability to implement such lockdowns widely eclipse the society of 1918. These are enormous differences.
I think you have it largely backwards, 1918 had more extreme lockdowns. Even though they where not uniform nationwide.
They had actual fines and up to 10 says of prison time for failing to follow mask mandate in SF. This was then copied by other cities in California and other states across the US.
In most places they just shut down schools without any remote learning whatsoever.
That said, the city vs country decide was much stronger before cars. We had less than 1/3 of todays population and large chunk of that was still living on single family farms.
Please provide support for your claim that large parts of society were under lockdown in wide areas of the US and the world during the 1918 pandemic. I can find no support for that myself.
From what I understand:
1. There were no wide lockdowns. Theaters, dancehalls and schools closed temporarily. But there were nothing like the mandatory and enforced lockdowns we've seen across the globe the last couple of years (China, Spain, France, Belgium, Netherlands, etc). The state did not pay people money to stay at home from work, which we've seen in many countries the last couple of years. Closing dancehalls is not a lockdown.
2. Breaking the mask mandate did not lead to prison time like you insinuate. The article says most infringements lead to "a stern warning".
3. Despite the relatively harsh restrictions SF did not fare particularly well counting the number of deaths from the illness.
I maintain my claim that it was *not* the scientific consensus before 2020 that wide swats of the population should be made to stay at home and not work as a response to an influenza pandemic.
> Roger Pielke’s Honest Broker framework(Pielke, 2007)
That was useful. Just as I got to that stage in the paper I was thinking, "well yeah but in a pandemic/emergency there's some value of people just being clear and not muddying the water" and that framework was useful to think about how to get the best result.
I very much understand that Sweden could have done better in response to the pandemic, but I feel that there are a lot of points where the paper is disingenuous.
> During 2020, however, Sweden had ten times higher COVID-19 death rates compared with neighbouring Norway.
As I understand it, the public health ministry avoided lockdowns partly because it argued it is a short-term strategy and partly because they did not find that it was lawful. To me, it does not seem fair to compare a strategy where one aims to reach goals in the long run, to a strategy that focuses on the short-term (and is deemed unlawful). Especially not since the paper only focuses on 2020. Good on Norway for having a strategy that worked well for them.
> In 2014, the Public Health Agency merged with the Institute for Infectious Disease Control; the first decision by its new head (Johan Carlson) was to dismiss and move the authority’s six professors to Karolinska Institute. With this setup, the authority lacked expertise and could disregard scientific facts.
I don't understand why the paper says "lacked expertise and could disregard scientific facts". That it fired six professors and therefore "could disregard scientific facts" does not seem to rhyme with that they have laboratories specifically for analyzing infectious disease? (Source, could only find Swedish version, sorry: https://www.folkhalsomyndigheten.se/om-folkhalsomyndigheten/...). During the pandemic they hired experts as consultants, as I understand it. So were those six professors paramount to the agency having scientific expertise?
> The Swedish pandemic strategy seemed targeted towards “natural” herd-immunity and avoiding a societal shutdown.
This claim seems hotly debated. I tried following the sources in the paper for this but only found paywalls or papers that only talked about herd immunity in general terms. Lucky for me, one of the better Swedish journalists, Emmanuel Karlsten, wrote a long post about it (Source, Swedish: https://emanuelkarlsten.se/tegnell-mejlen-sa-fick-flockimmun...). I read it as that the agency definitely had herd immunity under discussion but it is unclear how much they based their strategy on it. Openly they repeatedly mentioned that they were trying to save as many lives as possible, not (necessarily) achieve herd immunity.
Some of the more radical claims in the paper seem to come from Sörensen (who is also a co-author of the paper).
> Both the Prime Minister and Minister of Health and Social Affairs publicly declared they had no competence considering pandemics or medical issues. In effect the democratic institutions ceased to function (Sörensen 2020)
It's certainly ...interesting... to read. It's published in a Russian journal of social sciences (https://scindeks.ceon.rs/JournalDetails.aspx?issn=0085-6320) which I can't find that much information on since I don't speak Russian. Interesting headlines in the paper include "The Sovietization of the Swedish state" and "Totalitarian Democracy". Reading it I don't really feel like including a source like that helps the credibility of the paper published in nature.
From the closing parts of the abstract
> If Sweden wants to do better in future pandemics, the scientific method must be re-established, not least within the Public Health Agency.
I don't feel convinced by the paper that such a conclusion can be reached.
EDIT removed opinions that still can not be discussed in a sane manner.